Cor triatriatum sinister - ретка вродена срцева мана- наши искуства во дијагнозата и третманот во детска возраст

Cor triatriatum sinister is a rare congenital heart defect in which left atrium is divided in two parts with the fibromuscular membrane. The proximal atrium accepts the pulmonary veins with their blood flow, the distal or (real) atrium is usually empty and separated from the ventricle by the mitral valve. There is a constant communication between the two parts of the divided atrium by which the blood flow is redirected to the left ventricle. This defect is rare, usually isolated, but it might be combined with other congenital heart defects. We present cases of two children aged 8 and 3 years at the time of establishment the diagnosis. In both cases the main clinical signs were fatigue and heart murmur on auscultation. Anamnesis, clinical symptoms and signs, ECG, chest X ray and the gold standard – echocardiography were used for establishing the diagnosis. Definitive treatment was made with cardiosurgical resection of the fibromuscular membrane using extracorporeal circulation. Regular periodical evaluation is necessary in order to discover late complications of cardiac rhythm disturbancesCor triatriatum sinister е ретка срцева мана кај која левата преткомора е поделена на два дела со фибромускулна мембрана. Проксималната преткомора ги прима пулмоналните вени заедно со крвта која тие ја носат, а дисталната или (вистинска) преткомора е вообичаено празна и таа е поделена од комората со митралната валвула. Има постојана комуникација помеѓу двата дела на поделената преткомора преку која крвта се пренасочува кон левата комора. Маната е многу ретка, најчесто е изолирана, но може да оди во комбинација со други срцеви мани. Презентираме случаи на две деца на возраст од 8 и 3 години во времето кога е поставена дијагнозата. Кај обете причина за дијагнозата бил замор и чуен срцев шум. За поставување на дијагнозата беа користени анамнезата, клиничките знаци и симптоми, ЕКГ, рендген на срце и бели дробови и златниот стандард - ехокардиографијата. Дефинитивно излекување беше направено со изведување на кардиохируршка ресекција на фибромускулната мембрана со користење на екстракорпорална циркулација. Потребно е регуларно периодично следење на децата со цел откривање на доцни компликации од типот на нарушувања на срцевиот  ритам

Евалуација на педијатриски пациенти со јувенилен идиопатски артрит третирани со биолошка терапија Тоцилизумаб (Actemra)

Juvenile idiopathic arthritis (JIA) is the most common chronic disease in childhood. It manifests a heterogenic group of symptoms of arthritis, lasting at least 6 weeks and it appears before the age of 16. Patients who had no good therapeutic response to conventional therapy with Methotrexate were treated with biological therapy. The aim of this paper was to evaluate 9 patients who were receiving Tocilizumab at the Department of Rheumocardiology, University Clinic of Pediatric Diseases in Skopje. Materials and methods: Our study included 9 patients treated at our Department with biological therapy with Tocilizumab. Prior to initiation of the biological therapy, all patients underwent laboratory investigations, purified protein derivative (PPD) skin test for tuberculosis, X ray of the lungs and heart, and analysis of hepatitis markers. All patients were treated with amp. Actemra (tocilizumab) 8 mg/kg/tt i.v. Two of the patients had a severe form of the disease (one with severe systemic form and one with severe oligoarticular form of JIA). All presented patients had clinical remission of the disease. Conclusion: Therapy with tocilizumab in patients with juvenile idiopathic arthritis is a good therapeutic choice. The results obtained in our study have shown a significant therapeutic effect of tocilizumab even in severe forms of the disease.  Јувенилниот идиопатски артрит е најчеста форма на хронично заболување во детската возраст, кое се манифестира со  хетерогена група на симптоми на артрит коишто траат најмалку 6 недели, а се појавиле пред 16-годишна возраст. Пациентите кои не дадоа добар тераписки одговор на конвенционалната терапија со Метотрексат, беа префрлени на биолошка терапија. Целта на оваа студија беше да изврши евалуација на 9 пациенти кои примаа тоцилизумаб на Одделот за реумокардиологија на Универзитетската клиника за детски болести во Скопје. Материјали и методи: Во нашата студија  беа вклучени 9 пациенти третирани на нашиот Оддел со Тоцилизумаб во период од 2010-2020 година. Кај сите пациенти пред започнување на терапијата беа направени лабораториски иследувања, прочистен протеински деривативен кожен тест за туберкулоза (ППД), РДГ на градите, и маркери за хепатит. Сите пациенти беа третирани со амп. Актемра 8мг/кг/тт и.в. Два пациента имаа тешка клиничка презентација на јувенилен идиопатски артрит (првиот со тешка системска форма на болеста, а вториот со тешка олигоартикуларна форма). Кај сите третирани пациенти настана ремисија на клиничката слика по спроведување на терапијата. Заклучок: Биолошката терапија со тоцилизумаб кај пациентите со јувенилен идиопатски артрит е добар тераписки избор. Резултатите покажаа сигнификантен тераписки ефект дури и кај потешките облици на болеста

Craniofacial morphology in Turner syndrome karyotypes

ABSTRACT Introduction: A complete or partial absence of an X chromosome in the karyotype of phenotypic females has an impact on craniofacial morphology. The aim of this study was to determine the characteristics of the craniofacial complex in patients with Turner syndrome (TS), and to evaluate the influence of various karyotypes on craniofacial morphology. Material and methods: The study population was comprised of 40 TS female patients, aged 9.2 to 18 years, and 40 healthy females, aged 9.3 to 18 years, as the control group. The TS patients were subdivided according to karyotype. All study participants were evaluated cephalometrically. An analysis of variance (ANOVA) and Tukey’s multiple comparison test were used for analysis of the differences between the means in Turner subgroups and the control group. Results: In general, the girls with TS were characterized by smaller dimensions and an altered morphology of the craniofacial complex compared with the unaffected girls. The curvature of the frontal bone was significantly increased, while the diameter of the head was reduced. Both the maxilla and mandible were retrognathic, posteriorly rotated, and reduced in antero-posterior length. The cranial base was shorter and flattened. Among the different karoytypes, no significant differences were determined in the dimensions of the craniofacial complex in girls with TS. Conclusions: Our findings indicate that the karyotype has no effect on craniofacial morphology and we confirmed that a specific model of craniofacial morphology in individuals with TS is present in early childhood

Laser analgesic during orthodontic therapy

Introduction: Most of the patients feel pain 4 hours after the arch applying, gaining the highest level after 24 hours and its lowering in the next few days. Literature reports show that the fear of pain is a very important reason for discouraging the patient to agree for this kind of orthodontic treatment The aim of this study was to evaluate the effectiveness of the biostimulative laser treatment in pain reduction in patients with fixed orthodontic appliances. Materials and methods. Fifteen patients were treated with low energy level biostimulative diode laser, used 2 minutes per quadrant immediately after placement of fixed orthodontic appliances and in the following four days. The control group of 15 patients received analgesic therapy for period of five days. The pain was assessed subjectively as strong, medium or no pain. The pain disappeared in 20% of the subjects in the examined group after the first day, while in 60% and 26.6% of the subjects medium and isolated pain was still present at day 2 and 3, respectively. Results. The pain disappeared in all the patients treated with laser at day 5. In the control group, strong pain was present in all the subjects the first day, decreasing to 60% of strong pain and 20% medium pain the second day. After day three, the control group demonstrated medium localized pain in 40% of the cases, which dropped to 26.6% after the fourth day, suggesting delayed pain reduction, compared to the laser treated group. Conclusion. Our results suggest that the low energy laser treatment can successfully be used for pain reduction during the initial discomfort period after placing fixed orthodontic appliances

Cephalomteric analysis of the position of maxillary incisors at subjects with class II malocclusion

INTRODUCTION: Cephalometric analysis is combinations of measurements of craniofacial structures on the previous determined points and angles, which are used to assess craniofacial growth and development and to determine the type of orthodontic treatment and its response as well. MATERIAL AND METHOD:Our study was conducted on 50 lateral cephalometric tracings of subjects with mixed dentition aged 8-14 with malocclusion Class II division 1 and Class II division 2 in order to estimate the position of maxillary incisors at both malocclusions and their correlation with the type of growth and the basic planes of upper and lower jaw. Several angular and linear parameters were measured: SNA, SNB, ANB, 1/NA, 1/NB, Bjork polygon, 1/SpP, 1/MP, 1/NA, 1/NB. RESULTS: Results showed significant proclination of maxillary incisors at subjects with Class II division 1 malocclusion correlated with vertical type of growth which was opposite of the findings at subjects with Class II division 2-retroinclination of maxillary incisors and horizontal type of growth. Conclusion: Malocclusion Class II is among the most common occlusal irregularities at our population. It is determined with a distal position of lower jaw in correlation to maxillary complex (at most cases), but position of maxillary incisors divide this malocclusion on two divisions-Class II division 1 with protruded maxillary incisors, and Class II division 2 with retruded maxillary incisors

APPLICATION OF GEOSTATISTICS IN THE ANLYSIS AND ADAPTATION OF GEOTECHNICAL PARAMETERS AT COAL DEPOSITS

This paper presents case study in application of geostatistics in the analysis and adaptation of a representative values on the geotechnical parameters at coal deposits. In order to select the most reliable geotechnical values for the design process of open cast pit excavations of large heights, different pools of laboratory data sets have been processed. The following critical geotechnical parameters had been investigated: volume weight, angle of internal friction, moisture content. By applying the correct geostatistical tools, and in comparison with practical experience and removal of obvious outliers from the datasets, for one of the deposit are prepared so called “geotechnical domains”, shown in the form of spatial distribution maps of the analyzed parameters.  Advantages of the applied geostatistical approach are seen in enabling a higher confidence when performing slope stability analysis, selection of the most optimal geometry of the mines, lesser overburden quantities, protection of the environment, production cost cutting and time saving

Dental arch dimensions and palatal height in children with Turner syndrome

ABSTRACT Introduction: A complete or partial absence of an X chromosome in girls with Turner Syndrome (TS) has an impact on dental arch morphology. The aim of this study was to analyze the sizes of dental arches as well as the height of the palatal vault in patients with TS, and to determine the influence of various karyotypes on the study variables. Materials and methods: The study population sample consisted of 40 TS female patients, aged 9.2 to 18 years, and 40 healthy females aged 9.3 to 18 years, as the control group. The TS patients were subdivided according to karyotype (monosomy X, mosaic, and isochromosome). Dental arch width and length, and palatal height were measured directly on plaster dental casts. Results: The results showed differences in the dental arch dimensions between TS and control groups. The maxillary dental arch was narrower and shorter, but the mandibular arch was shorter and of normal width in the TS group. The palate in TS patients were normal in height and did not differ from those of the control subjects. Although the dental arch dimensions and palatal height were slightly reduced in mosaic and isochromosome karyotypes compared with those in 45,X females, the investigation revealed no significant differences between the karyotypes. Conclusions: Our findings indicate that the reduction of X chromosomal genetic material in Turner syndrome females results in the reduction of dental arch dimensions, which is further reflected in the increased frequency of malocclusion in these individuals. Importantly, this study demonstrates that palatal height is normal, contrary to some reports in the literature. It is further significant that the TS karyotype does not affect dentoalveolar morphology and palatal height